SEARCH RESULTS FOR: pleural-effusions-pathogenesis-and-anterior-posterior-chest-x-ray-findings

pleural-effusions-pathogenesis-and-anterior-posterior-chest-x-ray-findings

Pleural Effusions: Pathogenesis and Anterior-Posterior Chest X-Ray Findings Decubitus chest x-ray view causes fluid to accumulate on ipsilateral side. (Most sensitive view for small effusions) Excess fluid accumulation within pleural space that is gravity- dependent/free- flowing Large accumulation of fluid pressing against lung tissue and mediastinum Fluid layering (i.e. opacification) between lung and chest wall Author: Sravya Kakumanu Reviewers: Reshma Sirajee, Tara Shannon *Stephanie Nguyen, *Shelley Spaner * MD at time of publication Transudative pleural effusion *See Pathogenesis and Clinical Findings of Transudative Pleural Effusions slide Exudative pleural effusion *See Pathogenesis and Clinical Findings of Exudative Pleural Effusions slide Fluid accumulation at bottom of pleural space in anterior- posterior chest x- ray Lung atelectasis (lung collapse) Fluid is denser than air and appears white on x-ray ↓ Pressure and occupied space in thoracic cavity Meniscus sign (concave line above opacification) Opacification of affected pleural space Blunting of costophrenic angles Diaphragmatic silhouette sign (sharp diaphragm edge obscured by fluid) Mediastinal shift towards atelectic lung Contralateral mediastinal shift (when no lung atelectasis) Contralateral tracheal deviation Pleural infections ↑ Inflammation at infection site à↑ permeability of parietal pleura endothelium Bacterial invasion into pleural space from pulmonary parenchyma ↑ Migration of neutrophils and release of inflammatory cytokines in pleural space Inflammation ↑ activation of coagulation cascade and ↓ fibrinolytic activity ↑ Deposition of fibrin clots/membranes within pleural space creating septations Loculated pleural effusion/empyema (fluid stuck within septations within the pleural space) Opacification does not follow gravity Effusion does not move in decubitus view Pleural thickening (whitening of lung perimeter from fibrin deposition - more visible on CT scan) More rounded margins with chest wall/fissures Note: ~175-500mL of fluid may need to accumulate before being visible on an Anterior-Posterior Chest X-Ray Image credit: https://radiopaedia.org/cases/pleural-effusion-7 Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published May 22, 2022 on www.thecalgaryguide.com